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Student’s Name

Professor’s Name

PHEP 501 - Introduction to Epidemiology

Date

Epidemiological Study Designs and Methods

Part A - How do the methods and designs of epidemiological studies play a role in public

health?:

1. 1. What is the working title of the text you've been tasked with evaluating? Who is the

article's principal author? (i.e. the first author listed)?

For this assignment, I need to read and evaluate the paper " Epidemiological and Clinical

Differences in Sarcoidosis by Gender: A Population-Based Cohort Study, 1976-2013. Primary

authors are Professors Patompong Ungprasert, Cynthia S. Crowson, and Eric L. Matteson.

2. Describe the research design used in the publication you've been given and the main

features of that design.

To further understand how gender affects the prevalence and presentation of sarcoidosis,

Ungprasert et al. conducted a population-based cohort research. Researchers used a systematic

data extraction exercise as part of the study's design; this enabled them to get access to a

database including medical information for people living in Olmsted County, Minnesota,

according to the Rochester Epidemiological Project. By applying specific diagnostic codes for

noncaseating granuloma, sarcoidosis, and sarcoid, the researchers were able to locate and extract

all possible instances of sarcoidosis from 1976 through 2013.

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The relevant information was then recorded on a standardized data extraction form with

information on the demographic data, follow up periods, status at last follow up, and other

relevant diagnostic data.

3. Depending on the design of your assigned study how does this study design differ from

the following designs:case-control, prospective cohort, retrospective cohort, cross-

sectional, and ecological?

Unlike ecological studies which focuses on groups, this population-based cohort study focused

on individual medical records, thus in this kind of study individual-level data is present. Case-

control studies on the other hand focuses on comparisons of two groups of people while cross-

sectional designs focus on research during a single point in time (Georgetown University). The

population-based cohort study design used in the manuscript is a retrospective cohort study,

unlike this model where a researchers reviews data from subjects based on their exposure status,

prospective studies involves subject selection and recruitment before they develop any of the

outcomes of interest.

4. What was the primary study research question? This is usually noted within the

introductory section of a manuscript.

For the purpose of elucidating the clinical presentation and epidemiology of sarcoidosis,

Ungprasert et al. studied male and female patients with incident sarcoidosis in Olmsted County,

Minnesota, USA, between 1976 and 2013.

5. What appears to be the primary outcome that was investigated and analyzed? Were there

additional outcomes that were examined? This might be mortality related to a specific

disease, or the prevalence of a specific disease or health condition. Note whether there

was only one outcome that was evaluated.

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The researchers in this study intended to establish a correlation between the incidence of

sarcoidosis according to the sexes of the patients. While sex was the primary outcome under

investigation in this research article the researchers also established the relevance of age during

diagnosis of the disease, with most men being diagnosed while younger than the women at 42.8

years and 48.3 years respectively (Ungprasert et al. 3).

6. What appears to have been the study hypothesis in this study? Sometimes the research

study question is a generalized statement but it is related to a background study

hypothesis even if the hypothesis is not explicitly stated. Take note of any inferences you

can make about the study authors' hypotheses and how they could have framed the

research question. (The hypothesis is seen as a statement that may be tested statistically

on the link between an exposure and an outcome (disease or sickness). For example, in a

study of alcohol consumption and breast cancer the investigators may have hypothesized

that either alcohol consumption in general or high levels of alcohol may increase the risk

of breast cancer. Although this is often in the Introduction, it may be explicitly stated in

the Results or Discussion section.

A research was conducted to determine the impact of sex on the prevalence and clinical

presentation of sarcoidosis. The researchers might have hypothesized that sex might play a great

role in the incidence of the disease as all other research regarding ethnicity had been established.

In most published research on the influence of sex on the incidence of the disease, it was always

thought that females demonstrated higher rates compared to the men.

7. How were study subjects (participants) recruited and how many subjects were enrolled in

the study compared to how many actually participated in the study?

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Ungprasert et al. performed a cohort study wherein individuals were selected prospectively from a

dataset including all pertinent information. Consequently, there were no participants recruited for this

study, but instead subjects were chosen from an already available medical database. There were 345

sarcoidosis patients recognized as incident cases among the overall cohort.

8. How were data collected for the study?

Researchers extracted possible instances of sarcoidosis from the Rochester Epidemiology Project

database between 1976 and 2013 by utilizing diagnostic codes associated with noncaseating granuloma,

sarcoidosis, and sarcoid. The data researchers then entered the data into standardized extraction forms to

record appropriate information including demographic data, sex, ethnicity, and follow up times.

9. What was the main agent, exposure, or risk factor being investigated in relation to the

outcome? What types of covariates and confounders were evaluated? These are not the

same as what is often referred to as the primary outcome or main effect. Remember a

covariate or confounder is a variable that is thought to be relevant and important when

evaluating the association of interest between a primary exposure or risk factor and the

outcome. The relationship between alcohol consumption and the risk of breast cancer,

for instance, may be of primary interest for a study's research question, but other

influential factors, such as smoking, obesity, reproductive history, family history of

breast cancer, etc., must also be taken into account when evaluating this association.

After examining the study data and discussion, it is obvious that the primary risk factor related

with sarcoidosis was intra-thoracic illness. While this risk factor demonstrated in both the male

and the females, several pulmonary symptoms were more common in men than in women, thus

instigating the research into the inherent differences in manifestation of the disease between the

sexes.
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Part B - How can researchers utilize qualitative and quantitative approaches to learn more

about public health problems?:

1. What quantitative and qualitative data collection methods were selected in this study? If

qualitative methods were not used, please provide a brief narrative on what types of

qualitative methods could have been selected for such a study.

The study design used in this research used both quantitative and qualitative research methods.

For the quantitative aspect, the researchers collected the specific number of cases of sarcoidosis

incidence from 1976 to 2013, identifying 345 cases of the same. The qualitative aspect of the

research involved the identification of the extraction forms where descriptive data categorization

was required to identify the most appropriate cases for the study.

Part C - What Factors Affect a Population’s Health:

1. What, if any, environmental risk factors were examined in the assigned manuscript?

a. Explain their relevance in relation to the study outcome, if examined.

While there are no environmental risk factors examined in the assigned manuscript, the authors

mention the relevance of environmental exposure when investigating sarcoidosis. One of the

main manifestations of sarcoidosis as illustrated in the manuscript is intra-thoracic disease, with

symptoms including a slew of pulmonary presentations. Consequently, exposure to inhalable

irritants in the environment for example insecticides, molds, or other chemicals pertinent to one’s

occupation may influence the prevalence of sarcoidosis.

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b. Regardless of whether these factors were considered, find a publication (using

PUBMED) that addresses the environmental factors associated with either the

primary outcome in the assigned manuscript or an outcome of your choice.

A good example of a publication investigating the environmental risk factors associated with

sarcoidosis is Newman et al.’s “The National Library of Medicine has an article titled "A case

control etiologic investigation of sarcoidosis: environmental and occupational risk variables."

c. Explain how environmental factors may affect a population’s health.

Environment has been linked to sarcoidosis risk in the past. Several studies also confirm that

there is a positive correlation between different environmental factors, for example, pollutants

and other harmful substances in the environment which when exposed to people cause several

ailments. In this context, there is a positive correlation between people’s occupation (the

environments they spend most of their time) and several pulmonary conditions including

sarcoidosis (Newman 2).

2. What, if any, biological and genetic risk factors were examined in the assigned

manuscript?

a. Explain their relevance in relation to the study outcome, if examined.

There were no biological or genetic factors considered in the assigned manuscript.

b. Regardless of whether these factors were considered, find a publication (using

PUBMED) that addresses the biological and genetic factors associated with either the

primary outcome in the assigned manuscript or an outcome of your choice.

Calender et al.’s article, “New Understandings of the Functional and Clinical Implications of

Sarcoid Genetics,” is an excellent scientific resource on the correlation between biological and

genetic factors with the incidence and prevalence of sarcoidosis.

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c. To what extent could biological and genetic variables influence the health of a

population?

There are several biological and genetic predisposition that affects many illnesses. Consequently,

it is important for people to know their familial histories to know their susceptibility to some

genetic ailments. Currently, there are several pulmonary illnesses which can be associated with

various genetic and biological predispositions. Nonetheless, there is limited research suggesting

that sarcoidosis can be influenced by one’s genetics (Calender et al. ).

3. What if any behavioral and psychological risk factors were examined in the assigned

manuscript?

a. Explain their relevance in relation to the study outcome, if examined.

There were no behavioral and psychological factors considered in the assigned manuscript.

b. Regardless of whether these factors were considered, find a publication (using

PUBMED) that addresses the behavioral and psychological factors associated with

either the primary outcome in the assigned manuscript or an outcome of your choice.

None of the behavioral and psychological aspects related to the impact of sex on the

epidemiology and clinical symptoms of sarcoidosis have been explored in published papers.

c. Explain how behavioral and psychological factors may affect a population’s health.

Substance misuse and the associated medical problems are a major focus of behavioral and

psychological public health considerations. Behavioral factors often influences the introduction

of people to alcohol and other abusive substances which later develop to addiction which

proliferates public health issues related to the same.

4. What, if any, social, political, and economic risk factors were examined?

No political, social or economic risk factors were examined in this study.

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a. Explain their relevance in relation to the study outcome, if examined.

b. Regardless of whether these factors were considered, find a publication (using

PUBMED) that addresses the social, political, and economic factors associated with

either the primary outcome in the assigned manuscript or an outcome of your choice.

A good example of a publication investigating the social, political or economic risk factors

associated with sarcoidosis is Newman et al.’s “Studying the risk variables for sarcoidosis in a

case-control design,” published on the National Library of Medicine database.

c. Explain how social, political, and economic factors may affect a population’s health

Social, economic and political factors often contribute to the socio-economic status of different

peoples. Consequently, these pushes some people to go into occupations which have been

documented to have several public health concerns due to the nature of their jobs which may

include harmful substances which cause several illnesess.

Part D - How Are Results Used to Advance Public Health Knowledge:

1. How did the authors of your assigned manuscript use statistics to describe and assess the

specific populations being studied and to test their hypothesis?

Each cohort's characteristics were summarized using descriptive statistics (percentages, averages,

etc.). Chi-square and rank sum tests were used to make group comparisons. High, normal, or low

levels of adenosine deaminase (ACE) and calcium were identified. We utilized a logistic

regression model to examine whether or not the prevalence of pulmonary symptoms varied by

gender after accounting for smoking status.

2. With respect to the single most important finding in the study, what measure of

association was calculated? (Relative Risk, Odds Ratio, Hazard Ratio, Correlation

Coefficient, Regression Coefficient, Standardized Incidence Ratio).

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The measure of association calculated in the study was a Standardized Incidence Ratio based on

age-and sex-specific incidence rates.

3. What was the primary finding reported by the study authors and was it in keeping with

what they anticipated? (i.e. Was their hypothesis supported by the results?).

The primary results of the research indicated a 50/50 incidence ratio between males and female

suffering from sarcoidosis with the age at diagnosis slightly higher in females compared to the

males. These results did not support the hypothesis of the study.

4. What are the strengths and limitations identified by the authors of the study? This might

range from strengths that are noted such as large study sample to limitations such as the

possibility of particular forms of bias or small study sample size. The discussion of study

strengths and limitations is usually toward the end of the manuscript in the ‘Discussion’

section.

The significant limitations are those related with the study's retrospective character. Data on

clinical symptoms and laboratory examinations of patients were not collected and recorded in a

systematic manner. As a result, some relevant data may be unavailable.

5. How might the limitations impact the validity of the study and interpretation of the

findings with respect to public health?

The limitations of the study do not threaten the validity of the results since it was the study

design was retrospective.

6. How well did the authors discuss whether this study would further advance understanding

of the specific health condition and address gaps in knowledge and research?

The authors discussion of the results were concise yet simple. While they debunked their

hypothesis, they gained major insight on the age differences associated with the same outcomes
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they were investigating. They have identified a new area of scientific investigation which will be

helpful in understanding not only sarcoidosis, but other pulmonary diseases.

7. What might be a future next step to take after conducting this study?

While debunking their theory, they learned a lot about the age disparities related with the

outcomes they were looking into. They have discovered a new scientific field that will aid in the

study of not just sarcoidosis, but also other lung disorders.

8. Overall, how would you interpret the results of their data analysis for impact on public

health research?

There is no gender difference in the proclivity to develop sarcoidosis. Females in this research

were shown to be more severely affected by sarcoidosis in terms of uveitis and cutaneous

involvement, and to have been diagnosed at a later age than males.

9. How do you think the results of this study could be translated to public health policy and

prevention of this disease or health problem?

Since the study has established that there is no significant influence of sex on the incidence rates

of sarcoidosis, it has helped determine that public policies aimed to protect people based on

gender-centered occupations regarding respiratory diseases should be reviewed.

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Works Cited

Calender, Alain, et al. "Current insights in genetics of sarcoidosis: functional and clinical

impacts." Journal of Clinical Medicine 9.8 (2020): 2633.

Fletcher, Grant S. Clinical epidemiology: the essentials. Lippincott Williams & Wilkins, 2019.

Georgetown University. "Guides: Research in the Health Sciences: Research Design." Guides at

Dahlgren Memorial Library, 6 Sept. 2022, guides.dml.georgetown.edu/research/design.

Newman, Lee S., et al. "A case control etiologic study of sarcoidosis: environmental and

occupational risk factors." American journal of respiratory and critical care medicine

170.12 (2004): 1324-1330.

Ungprasert, Patompong, Cynthia S. Crowson, and Eric L. Matteson. "Influence of gender on

epidemiology and clinical manifestations of sarcoidosis: a population-based retrospective

cohort study 1976–2013." Lung 195.1 (2017): 87-91.